Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Science, Stockholm University, Stockholm, Sweden.
Uganda Cancer Institute, Kampala, Uganda.
J Med Internet Res. 2024 Oct 21;26:e65692. doi: 10.2196/65692.
Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers.
This study aims to assess the usage and usability of this mental health telephone service.
We obtained usage data from the system's call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated.
Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02).
We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings.
利用移动医疗（mHealth）解决方案可以改善心理健康服务的提供，并减轻其在乌干达和类似资源匮乏环境中的影响。然而，成功采用需要 mHealth 解决方案具有良好的可用性。我们之前实施了一项电话服务，以提供英语和卢干达语的心理健康信息和建议，利用与现场代理（包括心理健康护理人员和同伴支持人员）相关联的自动交互式语音应答（IVR）系统。
本研究旨在评估这项心理健康电话服务的使用情况和可用性。
我们从系统的 18 个月通话记录中获取使用数据，以研究通话量和趋势。然后，我们对来电者进行了调查，收集他们的特征，并使用远程医疗可用性问卷评估可用性。此外，通过 3 名独立的医疗保健专业人员使用电话护理对话流程对通话记录进行了质量评估，并调查了质量和可用性方面之间的相关性。
在 18 个月期间，系统收到了来自 1125 个唯一电话号码的 2863 条有意义的电话（即，超过欢迎信息的电话）。其中，1153 个电话（40.27%）停留在预先录制的 IVR 信息上，而 1710 个电话（59.73%）选择与代理通话。在选择与代理通话的人中，有 1292 个电话（75.56%）得到了接听，393 个电话（22.98%）转到语音信箱，并在接下来的工作日内回复，而 25 个电话（1.46%）未接听。使用率总体上持续稳定，通话量的峰值与营销活动相对应。调查（n=240）显示，大多数来电者是心理健康问题患者的照顾者（n=144，60.0%）或公众（n=46，19.2%），而少数是心理健康问题患者（n=44，18.3%）。此外，大多数来电者是男性（n=143，59.6%），讲英语（n=180，75.0%），接受过中学后教育（n=164，68.3%），居住在距离布塔比卡医院 1 小时或更短的时间内（n=187，77.9%），年龄在 25-44 岁之间（n=160，66.7%）。系统的整体可用性评分为 5 分制中的 4.12 分，显著高于推荐的 4 分目标可用性评分（P=.006）。可用性组件的平均得分为 3.66（可靠性）至 4.41（易用性），除可靠性外，所有组件的得分均高于 4 分或在其置信区间内。与英语使用者相比，卢干达语使用者的可用性评分更高，但与性别、距离医院、年龄、婚姻状况、症状持续时间或治疗状况等其他参与者特征没有关联。通话对话的质量（n=50）评分为 5 分制中的 4.35 分，并与可用性呈显著相关性（Pearson r=0.34，P=.02）。
我们发现心理健康电话服务的使用率持续稳定，用户体验良好，满意度高，涵盖了各种用户特征。像这样的 mHealth 解决方案应该被接受并复制，以加强乌干达和类似资源匮乏环境中的卫生服务提供。
